The Observatory’s Mission to Ensure Equity in Neonatal Assessments: Latest Guidelines
Recent Changes in Neonatal Care
Recently, two significant guidelines have been released that emphasise the need for inclusive clinical practice and education in neonatal care. In October 2024, the British Association of Perinatal Medicine (BAPM) introduced a new framework for practice, recommending routine pulse oximetry testing for all asymptomatic newborns of 34 weeks and above. Additionally, in November 2024, NHS England (NHSE) published National standards for neonatal Qualified in Specialty (QIS) education.
Both guidelines incorporate recommendations from the NHS Race and Health Observatory’s (RHO) review of neonatal assessment and practice report.
What Did We Say? And What Did They Do?
The Observatory neonatal report from July 2023 highlighted the importance of using objective measures such as pulse oximetry to assess newborns’ oxygenation levels. This recommendation has now been adopted by BAPM in their latest framework. The report also pointed out the challenges of visual detection of cyanosis in babies with dark skin tones, which can lead to disparities in care. BAPM’s framework acknowledges these issues and stresses superiority in the appropriate use of pulse oximetry over visual inspection, despite potential biases in the technology.
NHS England’s new standards for neonatal QIS education also reflect the Observatory’s recommendations. These standards ensure that clinical assessments and educational materials are inclusive of all skin tones, addressing the limitations of visual assessments for conditions like jaundice, hypoxia, and cyanosis.
What Should Clinicians Be Doing Now?
Clinicians should integrate the following practices into their routine assessments:
- Routine Pulse Oximetry Testing: Implement pulse oximetry for all newborns of 34 weeks and above to ensure accurate measurement of oxygen saturation levels. This objective measure is crucial for early detection and management of hypoxaemia, especially in babies with dark skin tones.
- Holistic Assessment: Combine objective measures with a thorough visual inspection to provide a comprehensive assessment. Be aware of the limitations of pulse oximetry and the potential for falsely reassuring readings in darker-skinned patients.
- Education and Awareness: Educate healthcare professionals and families about the differences in how hypoxaemia, cyanosis, and jaundice present in various skin tones. This knowledge is vital for early detection and intervention.
- Inclusive Educational Materials: Ensure that teaching materials and clinical manikins represent a diverse range of skin tones. Inclusivity in education will help prepare clinicians to provide equitable care to all newborns.
What’s Next?
The Observatory strongly supports further research into the effectiveness of pulse oximetry in newborns with a variety of skin tones. Continued investigation is essential to address any potential biases and ensure that pulse oximetry provides accurate readings for all babies. This commitment to research will help refine technology and assessments, and improve neonatal care practices, ensuring that all newborns receive the best possible care.
Addressing structural disparities in maternal and neonatal healthcare for Black, Asian and ethnic minority women and babies, and preventing avoidable deaths, is a key strategic priority for the Observatory. Part of our role is to convene a coalition of partners – patients, communities, healthcare workers, carers, policymakers and others – to collectively work towards a more equitable healthcare system for all.
Conclusion
Implementation of the Observatory’s recommendations in recently published guidelines from BAPM and NHSE marks a significant step towards more inclusive and effective neonatal care. By adopting routine pulse oximetry testing and ensuring that education and clinical practice are inclusive of all skin tones, we can improve outcomes for all newborns. Continued research and awareness are essential to address biases and to ensure that all babies receive the best possible care. This is a key strategic ambition for the Observatory.
For more information about the RHO visit: https://www.nhsrho.org/